Discussion

We identified ∼9 patients monthly with qualifying travel-related healthcare exposure in our ∼100-bed tertiary VA hospital, including ∼1.6 patients monthly with exposure outside the 50 U.S. states.

Identification of a single CPO-colonized patient on admission was meaningful; subsequent clinical cultures were CPO-positive such that early detection prevented a contact investigation (as is standard in our jurisdiction) and potentially an outbreak. The positive travel screening questionnaire and subsequent rapid CPO identification on admission prompted immediate contact precautions. Although VABA also detected this case soon after admission due to prior colonization, VABA requires engagement of subscribed local facility personnel and does not identify incident and previously detected non-VA cases.

Several operational challenges emerged. EHR limitations initially excluded certain admission types (ie, pretransplant) requiring informatics modifications. Communication gaps between infection prevention and clinical teams led to premature discontinuation of empiric precautions, underscoring the need for continued education. To improve adherence, visual cues placed outside patient rooms were introduced to indicate C. auris-specific environmental cleaning requirements, improving interdisciplinary coordination. Consideration was given to routine use of EPA-registered disinfectants active against C. auris but concerns regarding corrosiveness prevented adoption during the study period. ⁸

Prolonged C. auris TATs were driven by laboratory staffing limitations and weekend/holiday processing delays. Although bed flow was not impacted, the prolonged empiric contact precautions, often for the duration of hospitalization, created a larger-than-anticipated number of days in isolation with downstream effects such as increased gown and glove consumption alongside the potential for higher levels of patient depression and anxiety. ^{Reference Purssell, Gould and Chudleigh9} While testing was free through public health, other program costs included personnel time.

The implementation has been successful. The program benefits include the early detection of targeted MDROs to prevent outbreaks for travel-related exposures with relatively low operational impact. The screening question prioritized sensitivity over specificity, consistent with local public health recommendations. ^3,5 Future directions include more accurate identification of higher-risk exposures (eg, international, long-term acute care), evaluation of in-house C. auris testing to reduce TAT, and thoughtful consideration of additional ways to reduce days and impact of contact precautions.